Wyoming State Highlights

Tobacco use remains the leading cause of preventable death and disease in the United States and in Wyoming. To address this enormous toll, the American Lung Association in Wyoming calls for the following three actions to be taken by our elected officials: 1. Increase tobacco taxes; 2. Adopt a statewide, comprehensive smokefree law; and3. Maintain funding for tobacco prevention and cessation programs.

In 2016, Wyoming had a short legislative session focused almost exclusively on crafting the two year state budget for 2016 and 2017. Funding for tobacco prevention and cessation programs in Wyoming decreased slightly compared to the last two year state budget for 2014 and 2015 going from $4.6 million to $4.2 million per year. However, Wyoming remains one of only a handful of states that fund tobacco prevention and cessation programs at over 50 percent of the level recommended by the Centers for Disease Control and Prevention.

In past legislative sessions, the Wyoming Legislature has considered, but rejected legislation to increase Wyoming's excise tax on tobacco products, which stands at a meager 60 cents per pack currently. Raising Wyoming's cigarette tax by $1.25 per pack would raise over $50 million per two year period (biennium). This new revenue may become attractive to legislators who are looking for ways to compensate for lost revenue from a struggling minerals industry. The American Lung Association in Wyoming will be supporting increasing tobacco taxes in 2017 to reduce youth initiation and supports some of the new revenue being used to fund tobacco prevention and cessation programs as well.

Wyoming Facts

Economic Cost Due to Smoking:

$257,674,019

Adult Smoking Rate:

19.10%

Adult Tobacco Use Rate:

25.50%

High School Smoking Rate:

15.70%

High School Tobacco Use Rate:

38.40%

Middle School Smoking Rate:

5.40%

Smoking Attributable Deaths:

800

Adult smoking and tobacco use data come from CDC's 2015 Behavioral Risk Factor Surveillance System. High school smoking and tobacco use data come from the 2015 Youth Risk Behavior Surveillance System. Middle school smoking rate is taken from the Wyoming 2013 Youth Risk Behavior Surveillance System.

Health impact information is taken from the Smoking Attributable Mortality, Morbidity and Economic Costs (SAMMEC) software. Smoking attributable deaths reflect average annual estimates for the period 2005-2009 and are calculated for persons aged 35 years and older. Smoking-attributable health care expenditures are based on 2004 smoking-attributable fractions and 2009 personal health care expenditure data. Deaths and expenditures should not be compared by state.

To Get Involved, Contact:

Wisconsin State Highlights

Tobacco use remains the leading cause of preventable death and disease in the United States and in Wisconsin. To address this enormous toll, the American Lung Association in Wisconsin calls for the following three actions to be taken by our elected officials: 1. Prevent funding cuts to the statewide Tobacco Prevention and Control Program (TPCP);2. Enact legislation that would require all sales of tobacco products and e-cigarettes to be clerk assisted; and3. Continue to pass local ordinances that include e-cigarettes in those communities' comprehensive smokefree air laws, setting the groundwork for future state policy.

The American Lung Association in Wisconsin's chief accomplishment in 2016 was defeating a very bad e-cigarette bill that would not only have carved out a special exemption for the use of e-cigarettes in public places, but also would have prohibited local governments from enacting ordinances that aren't in strict compliance with state law. Passage of this law would ultimately have struck down numerous local ordinances that presently include e-cigarette use in their smokefree air policies.

While this effort was going on, the Lung Association continued to support strong local ordinances prohibiting the use of e-cigarettes in public places, in preparation for the day when Wisconsin is in the position to add them to its statewide smokefree air law.

Wisconsin also recently launched a new statewide tobacco control coalition which will provide leadership, direction and training/technical assistance for present and future tobacco control work and its partners.

Wisconsin's 2016 Youth Tobacco Survey demonstrates that Wisconsin is following the national trend of reducing cigarette smoking by high school and middle school students, but also shows an alarming increase in the use of other tobacco products (OTPs) - flavored cigars, smokeless tobacco - and e-cigarettes. Middle and high school cigarette smoking rates are presently 1.3 percent and 8.1 percent respectively, down from 2014, however use of e-cigarettes has risen to 2.6 percent and 13.3 percent respectively since 2014 - more than double their previous rates. The new survey results also show an increase in the use of flavored cigars and smokeless tobacco.

Wisconsin can greatly reduce kids' use of flavored tobacco products and e-cigarettes by enacting laws that treat these products the same as cigarettes. While the federal deeming regulation addresses product manufacturing, the rules are silent on issues such as flavorings, licensing, placement and other areas.

In Wisconsin, opportunities exist to address some of those gaps by moving OTPs and e-cigarettes behind counters or in locked cabinets, and creating greater equity in pricing. Presently, OTPs are taxed much lower than cigarettes - e-cigarettes are not taxed at all -- giving them a marked price advantage in addition to their "kid friendly" candy and fruit flavorings. Other equity issues that need to be addressed in 2017 include licensing requirements and free sampling laws.

Wisconsin Facts

Economic Cost Due to Smoking:

$2,663,227,988

Adult Smoking Rate:

17.30%

Adult Tobacco Use Rate:

20.20%

High School Smoking Rate:

8.10%

High School Tobacco Use Rate:

12.50%

Middle School Smoking Rate:

1.30%

Smoking Attributable Deaths:

7,850

Adult smoking and tobacco use data come from CDC's 2015 Behavioral Risk Factor Surveillance System. High school smoking and tobacco use and middle school smoking rates are taken from the 2015 Wisconsin Youth Tobacco Survey.

Health impact information is taken from the Smoking Attributable Mortality, Morbidity and Economic Costs (SAMMEC) software. Smoking attributable deaths reflect average annual estimates for the period 2005-2009 and are calculated for persons aged 35 years and older. Smoking-attributable health care expenditures are based on 2004 smoking-attributable fractions and 2009 personal health care expenditure data. Deaths and expenditures should not be compared by state.

To Get Involved, Contact:

West Virginia State Highlights

Tobacco use remains the leading cause of preventable death and disease in the United States and in West Virginia. To address this enormous toll, the American Lung Association in West Virginia calls for the following three actions to be taken by our elected officials: 1. Increase the excise tax on cigarettes by $1.00 per pack;2. Support comprehensive clean indoor air laws at the regional level; and3. Secure tobacco prevention and cessation funding from the general budget.

During the 2016 legislative session, after a delayed budget and long battle, a 65-cent cigarette tax increase was approved by the state legislature. This was the first increase in West Virginia's cigarette tax since 2003, and was a step forward to reduce tobacco use in the state. However, it was disappointing to the American Lung Association in West Virginia that state leaders missed an opportunity to achieve far greater public health benefits by increasing the tobacco tax by at least $1.00 per pack and dedicating a portion of the revenue to programs to prevent kids from smoking and help smokers quit. Other tobacco products such as cigars, snuff and chewing tobacco also will see a small jump in the excise tax with the rate going from 7 percent to 12 percent of the wholesale price. In addition, the legislature recognized the emerging threat of electronic cigarettes by placing a 7.5 cent per milliliter tax on the liquid nicotine in the products.

Through local boards of health, counties in West Virginia have added protections for workers from secondhand smoke and its health effects. Over 50 percent of West Virginia's population is protected by local smokefree regulations from exposure to secondhand smoke in public places and workplaces, including restaurants and bars. A couple of county boards of health have amended their smokefree regulations this year:* Mercer County strengthened its smokefree regulation by adding electronic smoking devices to it, and is considering making their existing smokefree regulation comprehensive. * Monongalia County further clarified the definition of smoking in its regulation to make clear its intent to prohibit the use of e-cigarettes and removed the exemption for hookah bar and bingo operations.

The American Lung Association in West Virginia will continue to educate lawmakers on the ongoing fight against tobacco. Our goal is to build champions within the legislature and a groundswell of advocates to advance our goals: a long overdue increase in the cigarette tax, parity between taxes on cigarettes and other tobacco products, comprehensive local clean indoor air laws and funding to prevent our youth from starting to smoke as well as helping individuals who want to quit to do so.

West Virginia Facts

Economic Cost Due to Smoking:

$1,008,474,499

Adult Smoking Rate:

25.70%

Adult Tobacco Use Rate:

32.80%

High School Smoking Rate:

16.20%

High School Tobacco Use Rate:

40.80%

Middle School Smoking Rate:

4.60%

Smoking Attributable Deaths:

4,280

Adult smoking and tobacco use data come from CDC's 2015 Behavioral Risk Factor Surveillance System. High school and middle school smoking rates are taken from the 2015 Youth Tobacco Survey. High school tobacco use rate is taken from the 2015 Youth Risk Behavior Surveillance System.

Health impact information is taken from the Smoking Attributable Mortality, Morbidity and Economic Costs (SAMMEC) software. Smoking attributable deaths reflect average annual estimates for the period 2005-2009 and are calculated for persons aged 35 years and older. Smoking-attributable health care expenditures are based on 2004 smoking-attributable fractions and 2009 personal health care expenditure data. Deaths and expenditures should not be compared by state.

To Get Involved, Contact:

Washington State Highlights

Tobacco use remains the leading cause of preventable death and disease in the United States and in Washington. To address this enormous toll, the American Lung Association in Washington calls for the following three actions to be taken by our elected officials: 1. Raise the legal age of sale for tobacco products to 21; 2. Increase funding for comprehensive tobacco prevention and control programs; and3. Tax electronic smoking devices to reduce youth use and fund tobacco prevention programs.

Washington's legislative bodies continue to struggle with budget challenges, in particular finding solutions to adequately fund education due to a court ruling finding the state negligent in providing adequate funding. The budget shortfalls continue to be an obstacle in securing adequate program funding for tobacco prevention efforts and cessation support.

Working together with coalition partners, the American Lung Association in Washington supported and celebrated the passage of Senate Bill 6328, "Concerning vapor products in respect to youth substance use prevention," during the 1st special legislative session in 2016. Advocates fought diligently to get the best possible bill to protect Washington's youth. The bill establishes important youth access protections for electronic cigarettes and provides more meaningful enforcement and penalties for those selling both tobacco products and electronic cigarettes to kids. The bill raised tobacco licensing fees and doubles fines for violations of tobacco sales laws. It also requires electronic cigarette retailers and other entities to get licenses. It was the first increase in 23 years to tobacco product licensing fees and penalties, and the dollars raised will pay for tobacco and e-cigarette enforcement, prevention and education efforts.

Bills were introduced to raise the age of sale for cigarettes to 21 in both the House and the Senate. Despite broad support for this legislation, neither bill moved to the floors for a vote.

Prior to the 2017 legislative session, a growing and strong coalition worked to provide strong support for another run to raise the legal age of sale for tobacco products to 21. Washington's Attorney General, Bob Ferguson, is a strong supporter of the policy as is Washington's Secretary of Health, John Weisman. Building on the support from the 2016 session, the Lung Association will again work to pass this legislation.

The American Lung in Washington will also continue to seek opportunities to secure funding for tobacco prevention programs and cessation support.

Washington Facts

Economic Cost Due to Smoking:

$2,811,911,987

Adult Smoking Rate:

15.00%

Adult Tobacco Use Rate:

17.40%

High School Smoking Rate:

7.90%

High School Tobacco Use Rate:

N/A

Middle School Smoking Rate:

4.00%

Smoking Attributable Deaths:

8,290

Adult smoking and tobacco use data come from CDC's 2015 Behavioral Risk Factor Surveillance System. High school (10th grade only) and Middle school (8th grade only) smoking rates are taken from the 2014 Washington State Healthy Youth Survey. A current high school tobacco use rate is not available for this state.

Health impact information is taken from the Smoking Attributable Mortality, Morbidity and Economic Costs (SAMMEC) software. Smoking attributable deaths reflect average annual estimates for the period 2005-2009 and are calculated for persons aged 35 years and older. Smoking-attributable health care expenditures are based on 2004 smoking-attributable fractions and 2009 personal health care expenditure data. Deaths and expenditures should not be compared by state.

To Get Involved, Contact:

Virginia State Highlights

Tobacco use remains the leading cause of preventable death and disease in the United States and in Virginia. To address this enormous toll, the American Lung Association in Virginia calls for the following three actions to be taken by our elected officials: 1. Increase the cigarette excise tax by at least $1.00 per pack;2. Create parity between taxes on cigarettes and other tobacco products; and3. Fund tobacco prevention and cessation programs at the Centers for Disease Control and Prevention (CDC)-recommended level.

In the 2016 legislative session, a bill to increase the state cigarette tax rate from $0.30 per pack to $1.50 per pack, the cigarette excise tax on roll-your-own tobacco from 10 percent of the manufacturer's sales price to 50 percent, and the tax rate on certain other tobacco products by the same percentage was introduced in the state House of Representatives. Ten percent of revenue on the three taxes would have been used by the Virginia Department of Health for tobacco cessation and prevention, and the remainder would have been deposited in the Virginia Health Care Fund. Unfortunately, the bill was left in the Finance Committee, and Virginia's cigarette tax remained the second lowest in the country.

Bills to authorize any county to impose a tax on cigarettes were also introduced in the House and state Senate. Again, both were left in their respective Finance Committees and died.

The American Lung Association in Virginia led efforts to urge the Pharmacy and Therapeutics Committee to give a favorable review for Medicaid coverage of benefits consistent with CDC recommendations and Virginia law, including FDA-approved pharmacotherapy products,

Several bills dealing with electronic cigarettes were also introduced in 2016, including a bill in the House that would have established a state tax on electronic cigarettes, and a bill in the Senate that would have expanded the definition of "smoking" in the Virginia Indoor Clean Air Act to include electronic cigarettes. The House bill was ultimately stricken from the docket by the Finance Committee, and Senate bill was passed by and died in the Local Government Committee.

In 2017, priorities for the American Lung Association in Virginia will include working to ensure prevention and cessation programs are funded, an increase in the cigarette excise tax, and parity between taxes on cigarettes and other tobacco products.

Virginia Facts

Economic Cost Due to Smoking:

$3,113,009,298

Adult Smoking Rate:

16.50%

Adult Tobacco Use Rate:

19.50%

High School Smoking Rate:

8.20%

High School Tobacco Use Rate:

22.70%

Middle School Smoking Rate:

1.60%

Smoking Attributable Deaths:

10,310

Adult smoking and tobacco use data come from CDC's 2015 Behavioral Risk Factor Surveillance System. High school smoking and tobacco use data come from the 2015 Youth Risk Behavior Surveillance System. Middle school smoking rate is taken from the Virginia 2015 Youth Risk Behavior Surveillance System.

Health impact information is taken from the Smoking Attributable Mortality, Morbidity and Economic Costs (SAMMEC) software. Smoking attributable deaths reflect average annual estimates for the period 2005-2009 and are calculated for persons aged 35 years and older. Smoking-attributable health care expenditures are based on 2004 smoking-attributable fractions and 2009 personal health care expenditure data. Deaths and expenditures should not be compared by state.

To Get Involved, Contact:

Vermont State Highlights

Tobacco use remains the leading cause of preventable death and disease in the United States and in Vermont. To address this enormous toll, the American Lung Association in Vermont calls for the following three actions to be taken by our elected officials: 1. Increase fiscal year 2018 funding for Vermont's comprehensive tobacco control program to $5.6 million; 2. Dedicate a percentage of annual tobacco tax revenue to sustain Vermont's efforts to prevent and reduce tobacco use; and 3. Raise the legal age for sale of tobacco products to 21.

After a complicated journey in the Vermont Legislature, the Governor signed into law a bill that eliminates the use of electronic cigarettes where smoking is prohibited, including in vehicles with children in car seats. The law was effective July 1, 2016.

For a second year, the Governor proposed to cut most of the budget for the state's Tobacco Evaluation and Review Board which oversees the independent evaluation of the tobacco control program. In 2015, the Lung Association and partners fought hard to restore the funding. In 2016, we lost the battle. The cut to the board's funding threatens the future of the board and ultimately, the effectiveness of the comprehensive tobacco control program.

The good news is that the fiscal year 2017 budget bill included language for "the Secretaries of Administration and Human Services, the Tobacco Evaluation and Review Board, and participating stakeholders to develop an action plan for tobacco program funding at a level necessary to maintain the gains made in preventing and reducing tobacco use that have been accomplished since their inception."

Rep. George Till, a physician, sponsored a bill to raise the legal age for sale of tobacco products to 21. The bill passed the House after a full day of debate. It contained several provisions of concern: 1) a graduated increase of the legal age over three years, 2) a corresponding cigarette tax of $.13 per pack each year, 3) an exemption for active duty military, and 4) an increase of the penalty for misrepresentation of age from $25 to $200. The bill died in the Senate but generated a lot of discussion about the state's effort to prevent and reduce tobacco use and provided a platform for strong legislation in 2017.

The American Lung Association in Vermont will continue to work with coalition partners, the American Heart Association and the American Cancer Society Cancer Action Network to advance tobacco control efforts and protect Vermont's tobacco control program and smokefree policies against rollbacks. We will continue to educate policy makers, business leaders and the media of the importance of Lung Association goals to reduce tobacco use and protect public health.

Vermont Facts

Economic Cost Due to Smoking:

$348,112,248

Adult Smoking Rate:

16.00%

Adult Tobacco Use Rate:

18.00%

High School Smoking Rate:

10.80%

High School Tobacco Use Rate:

24.70%

Middle School Smoking Rate:

2.00%

Smoking Attributable Deaths:

960

Adult smoking and tobacco use data come from CDC's 2015 Behavioral Risk Factor Surveillance System. High school smoking and tobacco use data come from the 2015 Youth Risk Behavior Surveillance System. Middle school smoking rate is taken from the Vermont 2015 Youth Risk Behavior Surveillance System. Results are rounded to the nearest whole number.

Health impact information is taken from the Smoking Attributable Mortality, Morbidity and Economic Costs (SAMMEC) software. Smoking attributable deaths reflect average annual estimates for the period 2005-2009 and are calculated for persons aged 35 years and older. Smoking-attributable health care expenditures are based on 2004 smoking-attributable fractions and 2009 personal health care expenditure data. Deaths and expenditures should not be compared by state.

To Get Involved, Contact:

Utah State Highlights

Tobacco use remains the leading cause of preventable death and disease in the United States and in Utah. To address this enormous toll, the American Lung Association in Utah calls for the following three actions to be taken by our elected officials: 1. Maintain or increase funding for state's tobacco prevention and control program; 2. Increase the minimum legal sales age for tobacco products to 21; and3. Raise Utah's tobacco tax to encourage an even further reduction in tobacco use.

The American Lung Association in Utah along with our partners at the Coalition for a Tobacco-Free Utah provide leadership and guidance for public policy efforts to continue the state's success in reducing the impact of tobacco among Utahans. Together with our partners, the Lung Association works to ensure tobacco control and prevention remains a priority for state legislators and local decision makers.

In 2016, the American Lung Association in Utah supported legislation that would have increased the legal age of sale for tobacco products to 21 years old from age 19 currently. Although the legislation did not make it out of the House Revenue and Taxation Committee, legislators were educated on the issue for when the bill is introduced in future legislative sessions.

Additionally the Lung Association supported legislation that would have eliminated smoking rooms at the Salt Lake City International Airport. The bill was defeated, however the city agreed not to include smoking rooms in its new replacement terminal eliminating secondhand smoke exposure for workers and travelers.

Funding for the Utah Tobacco Prevention and Control Program at the state Department of Health was again maintained at about the same level as previous years in fiscal year 2017. The program is funded by a combination of tobacco Master Settlement Agreement dollars and tobacco tax revenue.

In 2017, the American Lung Association in Utah will continue pushing to increase the sales age for tobacco products to 21, and to maintain or even increase funding for the Utah Tobacco Prevention and Control Program.

Utah Facts

Economic Cost Due to Smoking:

$542,335,526

Adult Smoking Rate:

9.10%

Adult Tobacco Use Rate:

11.10%

High School Smoking Rate:

4.40%

High School Tobacco Use Rate:

N/A

Middle School Smoking Rate:

N/A

Smoking Attributable Deaths:

1,340

Adult smoking and tobacco use data come from CDC's 2015 Behavioral Risk Factor Surveillance System. High school smoking rate is taken from the 2013 Youth Risk Behavior Surveillance System. Current high school tobacco use and middle school smoking rates are not available for this state.

Health impact information is taken from the Smoking Attributable Mortality, Morbidity and Economic Costs (SAMMEC) software. Smoking attributable deaths reflect average annual estimates for the period 2005-2009 and are calculated for persons aged 35 years and older. Smoking-attributable health care expenditures are based on 2004 smoking-attributable fractions and 2009 personal health care expenditure data. Deaths and expenditures should not be compared by state.

To Get Involved, Contact:

Texas State Highlights

Tobacco use remains the leading cause of preventable death and disease in the United States and in Texas. To address this enormous toll, the American Lung Association in Texas calls for the following three actions to be taken by our elected officials:1. Maintain or increase funding for tobacco prevention and cessation programs;2. Continue to pass comprehensive local smokefree ordinances to build towards a statewide smokefree law; and 3. Increase the minimum legal sales age for tobacco products to 21.

The American Lung Association in Texas along with our partners at Smoke-Free Texas provides leadership and guidance for public policy efforts to continue the state's success in reducing the impact of tobacco among Texans. Together with our partners, the American Lung Association in Texas works to ensure tobacco control and prevention remains a priority for state legislators and local decision makers.

There was no state legislative session in Texas in 2016, however, significant progress was made on passing local smokefree ordinances. Since January 2016, seven local smokefree ordinances have been passed, including the cities of Mesquite and Mission. Texas now has 52 cities with local smokefree ordinances that protect 9.8 million people from secondhand smoke in virtually all public places and workplaces. Efforts continue in the city of Fort Worth, Texas as well, which is the largest city in Texas that remains without a comprehensive smokefree ordinance.

Funding for tobacco prevention and cessation programs remained at $10.223 million as appropriated in the two-year state budget passed in 2015.

Moving forward in 2017, the American Lung Association in Texas and its partners will work to raise the minimum sales age for tobacco products to 21 as well as protect existing funding for tobacco prevention and cessation programs.

Texas Facts

Economic Cost Due to Smoking:

$8,855,602,443

Adult Smoking Rate:

15.20%

Adult Tobacco Use Rate:

17.70%

High School Smoking Rate:

14.10%

High School Tobacco Use Rate:

N/A

Middle School Smoking Rate:

N/A

Smoking Attributable Deaths:

28,030

Adult smoking and tobacco use data come from CDC's 2015 Behavioral Risk Factor Surveillance System. High school smoking rate is taken from the 2013 Youth Risk Behavior Surveillance System. A current high school tobacco use and middle school smoking rate is not available for this state.

Health impact information is taken from the Smoking Attributable Mortality, Morbidity and Economic Costs (SAMMEC) software. Smoking attributable deaths reflect average annual estimates for the period 2005-2009 and are calculated for persons aged 35 years and older. Smoking-attributable health care expenditures are based on 2004 smoking-attributable fractions and 2009 personal health care expenditure data. Deaths and expenditures should not be compared by state.

Tennessee State Highlights

Tobacco use remains the leading cause of preventable death and disease in the United States and in Tennessee. To address this enormous toll, the American Lung Association in Tennessee calls for the following three actions to be taken by our elected officials: 1. Repeal preemption as it relates to smokefree air laws in public places;2. Increase the tobacco tax by $1.00 per pack; and3. Increase the age of sale for tobacco products to 21.

It was a disappointing 2016 legislative session in Tennessee related to tobacco control policy. There was a Tobacco 21 bill filed by Representative Ramsey in the House that would not have even been heard in committee had it not been for the State Health Commissioner Dreyzehner testifying on behalf of it.

Preemption continues to be a barrier in passing any effective or strong smokefree laws in the state. The state of Tennessee passed legislation in 1994 giving complete control over tobacco regulation to the state. Protecting tobacco farmers in Tennessee was a large part of the rationale behind tobacco preemption at the time this legislation was passed.

Numerous health based tobacco coalition partners feel the time is ripe to fight tobacco preemption in Tennessee. There is a strong will for increased local control at our legislature as evidenced by increased de-annexation legislation in the last 2 years. There was also laws passed that allowed for exemptions to allow Ascend Amphitheater in Nashville and a major aquatic center in Kingsport to go smokefree. This began to set the stage for the possibility to challenge preemption in the state of Tennessee. The Lung Association and our partner organizations began to meet with state and local officials to gain support for a bill in 2017 that would repeal preemption in the state and give local control to communities to allow them to pass stronger smokefree laws.

In the meantime, on a local level there was positive voluntary smokefree movement in Chattanooga with an alliance of a number of mayors from the area who promoted smokefree parks and public places in their communities. A billboard and social media campaign launched the initiative and gained much earned media. In addition, Memphis and Kingsport worked on voluntary smokefree parks and public places as well and gained a lot of momentum and earned media in those communities.

Another major area of concern was the allotment of tobacco Master Settlement Agreement money to tobacco control and cessation programs for three years runs out in 2016, and no legislation to continue this funding was approved.

Overall, Tennessee legislators have much work to do to protect the people in the state from secondhand smoke, preventing kids from ever starting to smoke, and helping those who want to quit.

Tennessee Facts

Economic Cost Due to Smoking:

$2,672,824,085

Adult Smoking Rate:

21.90%

Adult Tobacco Use Rate:

26.50%

High School Smoking Rate:

11.50%

High School Tobacco Use Rate:

31.90%

Middle School Smoking Rate:

N/A

Smoking Attributable Deaths:

11,380

Adult smoking and tobacco use data come from CDC's 2015 Behavioral Risk Factor Surveillance System. High school smoking and tobacco use data come from the 2015 Youth Risk Behavior Surveillance System. A current middle school smoking rate is not available for this state.

Health impact information is taken from the Smoking Attributable Mortality, Morbidity and Economic Costs (SAMMEC) software. Smoking attributable deaths reflect average annual estimates for the period 2005-2009 and are calculated for persons aged 35 years and older. Smoking-attributable health care expenditures are based on 2004 smoking-attributable fractions and 2009 personal health care expenditure data. Deaths and expenditures should not be compared by state.

To Get Involved, Contact:

South Dakota State Highlights

Tobacco use remains the leading cause of preventable death and disease in the United States and in South Dakota. To address this enormous toll, the American Lung Association in South Dakota calls for the following three actions to be taken by our elected officials: 1. Ensure the full $5 million in dedicated tobacco tax revenue is allocated to tobacco prevention programs; 2. Protect South Dakota's comprehensive smokefree workplace law; and 3. Increase the tax on cigarettes and other tobacco products.

The South Dakota Department of Health along with national, state, and local partners continue to work together on a five-year tobacco strategic plan. The four goal areas of the plan include: preventing initiation of tobacco use, promoting quitting among adults and youth, eliminating exposure to secondhand smoke and identifying and eliminating tobacco-related disparities among population groups. Priority populations have been identified to include: American Indians, Medicaid enrollees, pregnant women, people with mental illness and substance use disorders, spit tobacco users, youth and young adults.

State funding for the state's tobacco prevention and control program remained at $4.5 million in fiscal year 2015, the same level as the past several years. When combined with federal funding this level is close to half of the level recommended by the Centers for Disease Control and Prevention (CDC).

South Dakota has a well-funded quitline compared to other states, but coverage of treatments to help smokers quit under the state Medicaid program is one of the least comprehensive in the country leading to the F grade for Access to Cessation Treatments.

Sioux Falls was one of the sites for the launch of FDA's "The Real Cost" campaign targeting youth ages 12-17, at risk of smokeless tobacco use. In 2016, the campaign expanded to have a presence during games in Minor League Baseball including both the Sioux City Explorers and the Sioux Falls Canaries.

The coalition in South Dakota has strong roots in working together to support tobacco control best practices and will continue to work in 2017 to assure funding for the state tobacco control program is not reduced any further and promote increasing funding to the CDC-recommended level. Other priorities include protecting the comprehensive statewide smokefree law and education toward increasing the tobacco tax in the future.

South Dakota Facts

Economic Cost Due to Smoking:

$373,112,273

Adult Smoking Rate:

20.10%

Adult Tobacco Use Rate:

25.00%

High School Smoking Rate:

10.10%

High School Tobacco Use Rate:

30.30%

Middle School Smoking Rate:

N/A

Smoking Attributable Deaths:

1,250

Adult smoking and tobacco use data come from CDC's 2015 Behavioral Risk Factor Surveillance System. High school smoking and tobacco use data come from the 2015 Youth Risk Behavior Surveillance System. A current middle school smoking rate is not available for this state.

Health impact information is taken from the Smoking Attributable Mortality, Morbidity and Economic Costs (SAMMEC) software. Smoking attributable deaths reflect average annual estimates for the period 2005-2009 and are calculated for persons aged 35 years and older. Smoking-attributable health care expenditures are based on 2004 smoking-attributable fractions and 2009 personal health care expenditure data. Deaths and expenditures should not be compared by state.

To Get Involved, Contact:

South Carolina State Highlights

Tobacco use remains the leading cause of preventable death and disease in the United States and in South Carolina. To address this enormous toll, the American Lung Association in South Carolina calls for the following three actions to be taken by our elected officials: 1. Increase funding for the state's tobacco prevention program; 2. Increase the number of comprehensive local smokefree air laws; and 3. Increase the price of tobacco products to reduce tobacco use among youth and adults.

The American Lung Association in South Carolina and partners in the South Carolina Tobacco-Free Collaborative continued to support passage of smokefree air ordinances at the local level in 2016. The state has about 62 local comprehensive smokefree ordinances covering about 40 percent of the state's population. Local governments have also begun to address smoking in parks and other recreational venues. A positive by-product of these ordinances has been increases in tobacco-free school campuses and tobacco-free colleges and universities. Funding for the state Tobacco Prevention and Control programs remained at $5 million in fiscal year 2017. The program receives all of its state funding from cigarette tax revenues, despite the fact that tobacco Master Settlement Agreement dollars are available. Legislation that would require cigarette tax stamps starting in 2019 did pass in the General Assembly and was signed by the Governor.

The South Carolina Tobacco-Free Collaborative (SCTFC) released Ending the Epidemic: Plan for a Tobacco-Free South Carolina, 2015-2020 in December 2015. This plan, developed by the SCTFC in collaboration with state partners and community coalitions, outlined strategies and recommendations to help reduce tobacco's toll on the Palmetto State. An evaluation of the previous five-year plan showed* A 19 percent decrease in the high school smoking rate;* An 8 percent decrease in the state adult smoking rate;* A 47 percent decrease in the middle school smoking rate; and* A 32 percent decrease in per capita cigarette pack sales.

Initial evidence suggests the following interventions contributed to the progress:* A cigarette tax increase of $1.12 per pack ($.50 state, $.62 federal);* A six-fold increase in the number of smokefree communities; * Increases in the numbers of tobacco-free school districts and college campuses; and* State and federal quit-smoking media campaigns.

The American Lung Association in South Carolina continues to work for more local smokefree air ordinances. We support improvements in quit smoking benefits for workers, increased tobacco taxes and increasing the $5 million dollar allocation in state tobacco prevention funding.

South Carolina Facts

Economic Cost Due to Smoking:

$1,906,984,487

Adult Smoking Rate:

19.70%

Adult Tobacco Use Rate:

22.80%

High School Smoking Rate:

9.60%

High School Tobacco Use Rate:

29.10%

Middle School Smoking Rate:

4.80%

Smoking Attributable Deaths:

7,230

Adult smoking and tobacco use data come from CDC's 2015 Behavioral Risk Factor Surveillance System. High school smoking and tobacco use data come from the 2015 Youth Risk Behavior Surveillance System. Middle school smoking rate is taken from the 2013 South Carolina Youth Tobacco Survey.

Health impact information is taken from the Smoking Attributable Mortality, Morbidity and Economic Costs (SAMMEC) software. Smoking attributable deaths reflect average annual estimates for the period 2005-2009 and are calculated for persons aged 35 years and older. Smoking-attributable health care expenditures are based on 2004 smoking-attributable fractions and 2009 personal health care expenditure data. Deaths and expenditures should not be compared by state.

To Get Involved, Contact:

Rhode Island State Highlights

Tobacco use remains the leading cause of preventable death and disease in the United States and in Rhode Island. To address this enormous toll, the American Lung Association in Rhode Island calls for the following three actions to be taken by our elected officials: 1. Raise the minimum age of sale for tobacco products from 18 to 21; 2. Add e-cigarettes to Rhode Island's smokefree workplace law; and3. Increase funding to the Rhode Island Department of Health's tobacco control program.

The 2016 Rhode Island legislative session included a little cigar tax bill that was championed by the American Lung Association in Rhode Island. In summary, this bill required taxing little cigars in the same manner as the tax imposed on cigarettes and that they be sold in packs of 20 or more. This bill passed in the state Senate but never made it to the state House of Representatives for a vote.

Other tobacco bills, although not victorious, but were at least introduced included: adding electronic cigarettes to the Rhode Island smokefree workplace law, adding sales and use taxes to electronic nicotine delivery systems (ENDS), prohibiting smoking in vehicles containing restrained children, raising the legal minimum age of sale for tobacco products from 18 to 21 and prohibiting the sale of ENDS liquid that is not contained in child-resistant packaging as well as prohibiting the use of ENDS products in schools.

The proposed fiscal year 2017 budget from Governor Raimondo once again included a 25-cent cigarette tax increase. As in previous years, none of the additional tax revenue was being dedicated to tobacco control programs, with the resulting price increase being too small to impact smoking rates amongst youth or adults. With strong opposition from public health advocates, including the American Lung Association in Rhode Island, this requested excise tax was defeated and not included in the final budget approved by the legislature.

Although it was a fairly neutral year for tobacco control state legislation, on the local level, there were some victories. The City of Central Falls, with support from the Lung Association and Tobacco Free RI, adopted comprehensive tobacco control regulations which included requiring local tobacco retail licensing, the elimination of tobacco discounts and promotions and the sale of flavored tobacco products, including e-cigarettes. Several other Rhode Island cities and towns considered similar regulations which are expected to gain traction in the upcoming year.

The American Lung Association will build on positive hearings in 2017 for bills that would raise the age of sale for tobacco products to 21, add ENDS products to the state's smokefree workplace law, and increase funding for the state's tobacco control program. Strong public support exists for these measures, which the Lung Association will seek to publicize and leverage with state legislators and policy makers.

Health impact information is taken from the Smoking Attributable Mortality, Morbidity and Economic Costs (SAMMEC) software. Smoking attributable deaths reflect average annual estimates for the period 2005-2009 and are calculated for persons aged 35 years and older. Smoking-attributable health care expenditures are based on 2004 smoking-attributable fractions and 2009 personal health care expenditure data. Deaths and expenditures should not be compared by state.

To Get Involved, Contact:

Pennsylvania State Highlights

Tobacco use remains the leading cause of preventable death and disease in the United States and in Pennsylvania. To address this enormous toll, the American Lung Association in Pennsylvania calls for the following actions to be taken by our elected officials: 1. Support a Youth Tobacco Prevention Package to include: a. Increase funding for tobacco prevention and cessation; b. Increase the licensure fee to sell tobacco products; c. Increase the age of sale for tobacco products to age 21; and2. Remove the exemptions from the current Clean Indoor Air Act that restricts smoking in public places and workplaces.

A major victory occurred during the 2016 legislative session when the Pennsylvania legislature passed a $1.00 per pack cigarette tax increase, which brings the total tax on cigarettes to $2.60 per pack. Also passed was the first ever tax on other tobacco products which imposed a 40 percent tax on the wholesale price of electronic cigarettes, including devices and liquid cartridges, and a 55-cent per ounce tax on any loose and smokeless tobacco products.

The cigarette tax increase will save an estimated 32,200 lives in Pennsylvania and keep more than 48,100 kids from becoming addicted adult smokers. The tax increase is also expected to prompt more than 65,600 adult smokers in Pennsylvania to quit, all while saving the state an estimated $2.19 billion in long-term health care costs.

While the American Lung Association in Pennsylvania was pleased with the decision to tax some other tobacco products there was an opportunity missed to fully protect residents from the health harms of tobacco by implementing a low, weight-based tax on smokeless and roll-your-own tobacco and not taxing cigars. These products, which are becoming increasingly popular among young people, are not safe alternatives to cigarettes.

A number of other tobacco-related bills were also introduced in the legislature in 2016, including several supported by the Lung Association. Two identical bills were introduced to remove exemptions from the current Clean Indoor Air Act - one in the Senate and one in the House. Both bills would also add electronic cigarettes to the current law. The House bill had a hearing in the Health Committee, but was weakened after a vote in the same committee and subsequently stalled.

A bill to further strengthen insurance coverage and access for cessation was supported by the Lung Association as well.

The American Lung Association in Pennsylvania will continue to educate lawmakers on the ongoing fight against tobacco. Our goal is to build champions within the legislature and a groundswell of advocates to advance our goals: to support a youth tobacco prevention package that increases funding for tobacco prevention and cessation, increases the license fee to sell tobacco products, and increases the sales age for tobacco products to 21. We will also continue to work to remove the exemptions from the current clean indoor air law.

Pennsylvania Facts

Economic Cost Due to Smoking:

$6,383,194,368

Adult Smoking Rate:

18.10%

Adult Tobacco Use Rate:

20.80%

High School Smoking Rate:

10.30%

High School Tobacco Use Rate:

32.30%

Middle School Smoking Rate:

1.30%

Smoking Attributable Deaths:

22,010

Adult smoking and tobacco use data come from CDC's 2015 Behavioral Risk Factor Surveillance System. High school and middle school smoking rates are taken from the 2015 Youth Tobacco Survey. High school tobacco use rate is taken from the 2015 Youth Risk Behavior Surveillance System.

Health impact information is taken from the Smoking Attributable Mortality, Morbidity and Economic Costs (SAMMEC) software. Smoking attributable deaths reflect average annual estimates for the period 2005-2009 and are calculated for persons aged 35 years and older. Smoking-attributable health care expenditures are based on 2004 smoking-attributable fractions and 2009 personal health care expenditure data. Deaths and expenditures should not be compared by state.

Oregon State Highlights

Tobacco use remains the leading cause of preventable death and disease in the United States and in Oregon. To address this enormous toll, the American Lung Association in Oregon calls for the following three actions to be taken by our elected officials: 1. Raise the legal age of sale for tobacco products to 21 years old; 2. Defend Oregon's smokefree workplace law; and3. Maintain funding for Oregon's tobacco prevention and cessation programs.

During Oregon's 2016 short 32-day legislative session several tobacco-related bills were discussed and given hearings.

Oregon is one of a few states without a retail licensing system for businesses selling tobacco products. Senate Bill 1559 was introduced to establish a licensing system with fees for tobacco retailers. Hearings were held, but the short session didn't allow for time to move the bill to the floors of the House of Representatives and Senate for votes.

Oregon legislators continued their discussions and proposals for the taxation of electronic smoking devices. No legislation was passed and this will remain an interest of legislators and stakeholders for the 2017 legislative session.

Increasing the minimum age of sale for tobacco products to 21 is garnering support around the state. Senator Elizabeth Steiner-Hayward is championing this policy and will be introducing legislation in 2017 for consideration. Momentum and support for this policy is growing with several local governments, including the city of Portland, showing support through consideration of their own local "Tobacco 21" policies.

In 2017, the Oregon legislature will be seeking solutions to address budget shortfalls which heightens the need for strong advocacy to maintain the current level of funding for tobacco prevention and cessation programs. Gov. Kate Brown's budget proposes an 85 cent increase in the tax on cigarettes. The American Lung Association in Oregon will be supporting a meaningful increase in this tax with a portion of the new revenue to support prevention and quit smoking programs.

Oregon Facts

Economic Cost Due to Smoking:

$1,547,762,592

Adult Smoking Rate:

17.10%

Adult Tobacco Use Rate:

19.90%

High School Smoking Rate:

8.80%

High School Tobacco Use Rate:

23.70%

Middle School Smoking Rate:

4.30%

Smoking Attributable Deaths:

5,470

Adult smoking and tobacco use data come from CDC's 2015 Behavioral Risk Factor Surveillance System. High school (11th grade only) smoking and tobacco use and middle school (8th grade only) smoking rates are taken from the 2015 Oregon Healthy Teens Survey.

Health impact information is taken from the Smoking Attributable Mortality, Morbidity and Economic Costs (SAMMEC) software. Smoking attributable deaths reflect average annual estimates for the period 2005-2009 and are calculated for persons aged 35 years and older. Smoking-attributable health care expenditures are based on 2004 smoking-attributable fractions and 2009 personal health care expenditure data. Deaths and expenditures should not be compared by state.

To Get Involved, Contact:

Oklahoma State Highlights

Tobacco use remains the leading cause of preventable death and disease in the United States and in Oklahoma. To address this enormous toll, the American Lung Association in Oklahoma calls for the following three actions to be taken by our elected officials: 1. Maintain dedicated funding for tobacco prevention and cessation programs;2. Increase the cigarette tax by at least a $1.00 per pack; and3. Pass a comprehensive statewide smokefree law that protects all workers and patrons from secondhand smoke.

During the 2016 legislative session, a bill was introduced to increase the cigarette tax by $1.50 per pack. The bill passed through several committees before failing on the floor of the House of Representatives. A $1.50 per pack cigarette tax would provide big benefits to the state, including preventing nearly 32,000 Oklahoma kids from starting to smoke, prompting nearly as many adults to quit and preventing approximately 18,000 tobacco-related deaths.

Dedicated funding from the tobacco Master Settlement Agreement (MSA) for the Oklahoma Tobacco Settlement Endowment Trust (TSET) remained intact for fiscal year 2017, and the amount of funding dedicated to tobacco prevention and cessation programs by TSET even increased by close to $1.5 million. Oklahoma voters made a wise decision by putting 75 percent of MSA payments each year into TSET, and the Lung Association will oppose any attempts to raid these funds by the legislature.

Program initiatives of TSET and the Oklahoma Department of Health to prevent and reduce tobacco use include the Oklahoma Tobacco Helpline at 1-800-QUIT-NOW, cessation systems grants, community grants covering over 85 percent of the state's population, funding for tribal nations and other priority populations and statewide media campaigns intended to change the social norms related to tobacco use.

In 2017, the American Lung Association in Oklahoma, along with strong public health partners, will continue to raise public awareness regarding the need for a comprehensive statewide smokefree law. We will also be supporting legislation that would increase the cigarette tax by a $1.00 per pack or more, and continue to protect funding for TSET and the Oklahoma Department of Health.

Oklahoma Facts

Economic Cost Due to Smoking:

$1,622,429,589

Adult Smoking Rate:

22.20%

Adult Tobacco Use Rate:

26.90%

High School Smoking Rate:

13.10%

High School Tobacco Use Rate:

31.40%

Middle School Smoking Rate:

4.80%

Smoking Attributable Deaths:

7,490

Adult smoking and tobacco use data come from CDC's 2015 Behavioral Risk Factor Surveillance System. High school smoking and tobacco use data come from the 2015 Youth Risk Behavior Surveillance System. Middle school smoking rate is taken from the 2013 Youth Tobacco Survey.

Health impact information is taken from the Smoking Attributable Mortality, Morbidity and Economic Costs (SAMMEC) software. Smoking attributable deaths reflect average annual estimates for the period 2005-2009 and are calculated for persons aged 35 years and older. Smoking-attributable health care expenditures are based on 2004 smoking-attributable fractions and 2009 personal health care expenditure data. Deaths and expenditures should not be compared by state.

To Get Involved, Contact:

Ohio State Highlights

Tobacco use remains the leading cause of preventable death and disease in the United States and in Ohio. To address this enormous toll, the American Lung Association in Ohio calls for the following three actions to be taken by our elected officials: 1. Match the tax on non-cigarette forms of tobacco like spit tobacco, cigars and hookah to the cigarette tax;2. Increase funding for tobacco prevention and cessation programs; and3. Pass Tobacco 21 laws to increase the minimum age of sale for tobacco products to 21 in additional cities in the state.

During the 2016 legislative session, a bill was introduced that would have allowed exemptions for a wide range of businesses under Ohio's Smoke-Free Workplace Act. The American Lung Association in Ohio and partners spoke with legislators and worked to obtain negative media stories about the legislation. Ultimately, the legislation did not get a hearing and made no progress during the legislative session.

The Lung Association worked with coalitions and other interested parties around the state to help move their cities closer to passing laws to increase the minimum sales age for tobacco products to 21 often referred to as Tobacco 21 laws. In 2016, groups in over a dozen cities worked toward passing a Tobacco 21 ordinance in their city. By the end of 2016, seven cities in Ohio, including the cities of Cleveland and Columbus, had passed Tobacco 21 laws. Columbus set up a local licensing system in conjunction with passage of its Tobacco 21 law, which should help with enforcement, and could serve as a good model for other cities to use.

A new poll released around the 10th anniversary of Ohio's Smoke-Free Workplace Act by the American Lung Association in Ohio, the American Cancer Society Cancer Action Network and the American Heart Association shows that the Smoke-Free Workplace Act islaw continues to be extremely popular among voters. Eighty-five percent of voters indicated they support the law. The same poll also showed that 92 percent of voters supported dedicating funding to programs to prevent tobacco use among kids and help smokers quit.

The 2016 Ohio Health Issues Poll sponsored by Interact for Health found that 53 percent of Ohio adults favored increasing the minimum purchase age for tobacco to 21, including about half of current smokers (51 percent), previous smokers (54 percent), and adults who had never smoked (54 percent). The poll also found high support for the law that prohibited smoking in any public place or place of employment. More than 8 in 10 Ohio adults (82 percent) were in favor of the law. Additionally, the survey found that 2 in 10 Ohio adults (19 percent) reported that they had ever used an e-cigarette. Those who used e-cigarettes included 51 percent of current smokers, 18 percent of former smokers, and 7 percent of adults who have never smoked.

As we look to 2017, the American Lung Association in Ohio will continue to work with a broad coalition of stakeholders to raise the tax on other tobacco products, fully fund evidence-based tobacco prevention and cessation programs, and pass Tobacco 21 laws in Ohio's cities.

Ohio Facts

Economic Cost Due to Smoking:

$5,647,310,236

Adult Smoking Rate:

21.60%

Adult Tobacco Use Rate:

24.60%

High School Smoking Rate:

15.10%

High School Tobacco Use Rate:

N/A

Middle School Smoking Rate:

2.60%

Smoking Attributable Deaths:

20,180

Adult smoking and tobacco use data come from CDC's 2015 Behavioral Risk Factor Surveillance System. High school smoking rate is taken from the 2013 Youth Risk Behavior Surveillance System. Middle school smoking rate is taken from the 2014 Youth Tobacco Survey. A current high school tobacco use rate is not available for this state.

Health impact information is taken from the Smoking Attributable Mortality, Morbidity and Economic Costs (SAMMEC) software. Smoking attributable deaths reflect average annual estimates for the period 2005-2009 and are calculated for persons aged 35 years and older. Smoking-attributable health care expenditures are based on 2004 smoking-attributable fractions and 2009 personal health care expenditure data. Deaths and expenditures should not be compared by state.

North Dakota State Highlights

Tobacco use remains the leading cause of preventable death and disease in the United States and in North Dakota. To address this enormous toll, the American Lung Association in North Dakota calls for the following three actions to be taken by our elected officials:1. Keep the current fully-funded tobacco prevention program and smokefree air laws strong;2. Raise the state tobacco tax currently at .44 per pack; and3. Raise the age of sale for all tobacco products to 21 years old.

There was no state legislative session in North Dakota during 2016, and therefore funding for the state tobacco control program remained the same for fiscal year 2017 at close to $10 million per year. When federal funding is included, North Dakota is one of only two states in the country that currently funds its state tobacco control program at the level recommended by the Centers for Disease Control and Prevention.

North Dakota has the fourth lowest cigarette tax in the country at 44 cents per pack. The tax has not been raised since 1993. After multiple attempts to get the tax increased during legislative sessions; advocates, including the American Lung Association in North Dakota, attempted to increase this abysmally low tax rate by activating over 150 volunteers to collect over 22,000 signatures to put an initiative on the November 2016 ballot to increase the cigarette tax by $1.76 per pack. The Raise it for Health Coalition representing over 30 partners from across the state, worked to educate voters on this important initiative. The tobacco industry including both Altria and RJ Reynolds poured over $3.7 million dollars to fight the initiative with misleading ads. Ultimately, the initiative was defeated.

The American Lung Association in North Dakota will continue its work in 2017 to educate both state and local decision makers about the benefits of a higher tobacco tax, increasing the sales age for tobacco products to 21 and keeping the current comprehensive tobacco control program fully-funded.

North Dakota Facts

Economic Cost Due to Smoking:

$325,798,988

Adult Smoking Rate:

18.70%

Adult Tobacco Use Rate:

23.90%

High School Smoking Rate:

11.70%

High School Tobacco Use Rate:

31.10%

Middle School Smoking Rate:

3.60%

Smoking Attributable Deaths:

980

Adult smoking and tobacco use data come from CDC's 2015 Behavioral Risk Factor Surveillance System. High school smoking and tobacco use data come from the 2015 Youth Risk Behavior Surveillance System. Middle school smoking rate is taken from the 2015 Youth Tobacco Survey.

Health impact information is taken from the Smoking Attributable Mortality, Morbidity and Economic Costs (SAMMEC) software. Smoking attributable deaths reflect average annual estimates for the period 2005-2009 and are calculated for persons aged 35 years and older. Smoking-attributable health care expenditures are based on 2004 smoking-attributable fractions and 2009 personal health care expenditure data. Deaths and expenditures should not be compared by state.

To Get Involved, Contact:

North Carolina State Highlights

Tobacco use remains the leading cause of preventable death and disease in the United States and in North Carolina. To address this enormous toll, the American Lung Association in North Carolina calls for the following three actions to be taken by our elected officials: 1. Restore funding for tobacco use prevention and cessation programs, including QuitlineNC; 2. Resist attempts to weaken the smokefree restaurants and bars law and expand the law to include all public places and private worksites; and3. Increase the state cigarette tax by $1.00 per pack.

Current funding for the state's tobacco use prevention and cessation program is perilously low. In 2011, tobacco use prevention and cessation programs jointly received $17.3 million. The 2016 remaining state funding for QuitlineNC, the state's phone counseling service for tobacco users, is $1.1 million. That is a very small amount of funding for a state as large as North Carolina. When federal funding is included, the amount is only 3.3 percent of the Centers for Disease Control and Prevention recommended funding level for the state. As of March 2016, demand for QuitlineNC services became greater than resources available. The evidence-based services were cut back in some instances to avoid shutting down the Quitline before the end of the fiscal year. There are no state dollars allocated for teen tobacco use prevention, even though a majority of smokers begin smoking by age 18. This lack of funding directly impacts the state's ability to move towards a healthier future.

In 2016, the Legislature did allocate $250,000 in funding for You Quit, Two Quit, a program to screen and treat tobacco use in women of reproductive age, pregnant and postpartum mothers. It was a welcome recognition of the value of evidence-based cessation strategies by our elected officials. Sen. Stan Bingham sought funding to create a program within the Division of Public Health to provide evidence-based tools and information to pediatricians and family physicians to enable them to better counsel their young patients and the parents of those patients about the health risks of electronic cigarettes, cigarettes, and other tobacco products. Unfortunately, it did not make it through the budget process.

The American Lung Association in North Carolina will continue to partner with the North Carolina Alliance for Health as it defends against any threats or attempts to weaken the smokefree restaurants and bars law and weighs options for strengthening protections for nonsmokers. Emphasis will be placed on restoring funding for tobacco use prevention programs to previous levels and to increase funding for QuitlineNC.

North Carolina Facts

Economic Cost Due to Smoking:

$3,809,676,476

Adult Smoking Rate:

19.00%

Adult Tobacco Use Rate:

22.50%

High School Smoking Rate:

9.30%

High School Tobacco Use Rate:

27.50%

Middle School Smoking Rate:

2.30%

Smoking Attributable Deaths:

14,220

Adult smoking and tobacco use data come from CDC's 2015 Behavioral Risk Factor Surveillance System. High school smoking and tobacco use and middle school smoking rates are taken from the 2015 North Carolina Youth Tobacco Survey.

Health impact information is taken from the Smoking Attributable Mortality, Morbidity and Economic Costs (SAMMEC) software. Smoking attributable deaths reflect average annual estimates for the period 2005-2009 and are calculated for persons aged 35 years and older. Smoking-attributable health care expenditures are based on 2004 smoking-attributable fractions and 2009 personal health care expenditure data. Deaths and expenditures should not be compared by state.

To Get Involved, Contact:

New York State Highlights

Tobacco use remains the leading cause of preventable death and disease in the United States and in New York. To address this enormous toll, the American Lung Association in New York calls for the following three actions to be taken by our elected officials: 1. Raise the age of sale for tobacco products to 21;2. Expand the state Clean Indoor Air Act to restrict the use of electronic cigarettes; and3. Increase the level of funding for the Tobacco Control Program from $39.3 million to $52 million per year.

During the 2016 legislative session we once again advocated extensively for an increase in the Tobacco Control Program funding, requesting an increase of $12.7 million. A sign-on letter was circulated throughout both houses of the legislature. A large number of representatives signed on to the letter in both houses. Unfortunately, this session saw significant competing interests for budgetary resources. While a number of programs took a cut in the 2016 budget, the tobacco control program, although not receiving the increase as hoped, did receive level funding.

The Lung Association commends New York for recently expanding smoking cessation coverage to include full coverage for cessation medications for the Medicaid population. This is an important step forward and we hope it will lead to even broader coverage without barriers for all New Yorkers.

The next major priority in the 2016 session was to again push for legislation prohibiting the use of electronic cigarettes indoors. For the first time since this bill was written several years ago, the Senate, including Senate leadership, indicated support for the legislation in 2016. This was largely a result of the final deeming rule being released by the U.S. Food and Drug Administration which elected to define electronic cigarettes as tobacco products. The bill did not make it through the Senate in 2016, but the prospects look good in 2017. Meanwhile, the bill passed the Assembly with less debate than previous years with seven members changing their positions from 'no' to 'yes' votes.

Legislation to increase the minimum age of sale for tobacco products to 21 often referred to as Tobacco 21 saw major movement on the local level during 2016. Albany, Schenectady, Cortland, Cattaraugus and Chautauqua have voted to raise the age of sale to 21, joining Suffolk County and New York City in doing so. Currently a number of other counties are considering similar legislation. As of September 2016, more than 50 percent of the state's population was covered by a Tobacco 21 law.

During the 2017 legislative session, the American Lung Association in New York will push to ensure a bill is passed that expands the state's smokefree law to restrict the use of electronic cigarettes, and capitalize on the movement of communities in New York to raise the age of sale for tobacco products to 21 statewide.

New York Facts

Economic Cost Due to Smoking:

$10,389,849,268

Adult Smoking Rate:

15.20%

Adult Tobacco Use Rate:

16.80%

High School Smoking Rate:

8.80%

High School Tobacco Use Rate:

28.80%

Middle School Smoking Rate:

1.20%

Smoking Attributable Deaths:

28,170

Adult smoking and tobacco use data come from CDC's 2015 Behavioral Risk Factor Surveillance System. High school smoking and tobacco use data come from the 2015 Youth Risk Behavior Surveillance System. Middle school smoking rate is taken from the New York 2014 Youth Tobacco Survey.

Health impact information is taken from the Smoking Attributable Mortality, Morbidity and Economic Costs (SAMMEC) software. Smoking attributable deaths reflect average annual estimates for the period 2005-2009 and are calculated for persons aged 35 years and older. Smoking-attributable health care expenditures are based on 2004 smoking-attributable fractions and 2009 personal health care expenditure data. Deaths and expenditures should not be compared by state.

New Mexico State Highlights

Tobacco use remains the leading cause of preventable death and disease in the United States and in New Mexico. To address this enormous toll, the American Lung Association in New Mexico calls for the following three actions to be taken by our elected officials: 1. Maintain or increase funding for state's tobacco prevention and control program; 2. Protect New Mexicans from secondhand smoke, including in multi-unit housing; and3. Raise the tax on cigarettes and other tobacco products including snuff, chew and cigarillos.

The American Lung Association in New Mexico provides leadership in convening partners and guiding public policy efforts to continue the state's success in reducing the impact of tobacco among New Mexicans. Together with our partners, the American Lung Association in New Mexico works to ensure tobacco control and prevention remains a priority for state legislators and local decision makers.

In 2016, our focus was to continue to educate legislators, legislative staff, and the general public about smoking and the importance of providing tobacco cessation programs for adults and youth, and the dangers of secondhand smoke. During the legislative session the Lung Association along with our partners were unsuccessful in passing a $1.00 per pack cigarette tax that would have increased the tax to $2.66 per pack. The legislation, which included parity between the tax on cigarettes and other tobacco products would have generated $33 million in new revenue for the state of New Mexico.

Also during the 2016 legislative session, funding for the New Mexico Tobacco Use Prevention and Control program was cut by $246,000 for fiscal year 2017.

The American Lung Association in New Mexico's Smoke-Free @ Home program provides education and support to property managers and owners on the economic and health benefits of implementing smokefree policies in multi-unit housing. In 2016, the Lung Association continues to help public and affordable housing implement smokefree policies building on our efforts from previous years.

Moving forward in 2017, the American Lung Association in New Mexico will once again make it a priority to educate our legislature and communities about the dangers of tobacco use and the importance of a well-funded tobacco prevention and cessation program as well as oppose any additional cuts. A $1.00 cigarette tax increase as well as tax parity between cigarettes and other tobacco products could provide additional revenue for the tobacco prevention and cessation program to avoid further cuts, and is something the Lung Association will continue advocating for.

Finally, the Lung Association will continue its focus on creating smokefree multi-unit housing in 2017. It is our goal to provide all New Mexicans with a safe and healthy living environment, free from the dangers of secondhand smoke.

New Mexico Facts

Economic Cost Due to Smoking:

$843,869,235

Adult Smoking Rate:

17.50%

Adult Tobacco Use Rate:

20.00%

High School Smoking Rate:

11.40%

High School Tobacco Use Rate:

32.20%

Middle School Smoking Rate:

6.80%

Smoking Attributable Deaths:

2,630

Adult smoking and tobacco use data come from CDC's 2015 Behavioral Risk Factor Surveillance System. High school smoking and tobacco use data come from the 2015 Youth Risk Behavior Surveillance System. Middle school smoking rate is taken from the New Mexico 2011 Youth Risk Behavior Surveillance System.

Health impact information is taken from the Smoking Attributable Mortality, Morbidity and Economic Costs (SAMMEC) software. Smoking attributable deaths reflect average annual estimates for the period 2005-2009 and are calculated for persons aged 35 years and older. Smoking-attributable health care expenditures are based on 2004 smoking-attributable fractions and 2009 personal health care expenditure data. Deaths and expenditures should not be compared by state.